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Abstract

Gram-negative bacilli are assuming an increasing role in nosocomial infections, having surpassed staphylococci in frequency of occurrence. In addition to the well-recognized syndromes of pyelonephritis and gram-negative rod bacteremia, a characteristic necrotizing pneumonia caused by gram-negative bacilli has been identified at autopsy. Pathological characteristics include necrosis of alveolar walls and bronchioles, extensive polymorphonuclear infiltration, and large numbers of gram-negative bacilli. Its frequency in autopsies at Parkland Memorial Hospital increased from 3% in 1935 to 10% in 1963 (P < 0.01). This report describes a group of patients with fatal necrotizing pneumonia selected to illustrate potential factors in its pathogenesis.